Updated to reflect the current ethical climate, this book presents clinical practice cases in which arguments can be made for differing courses of action or in which the obligations of the professional are in conflict; the reader is asked to determine the ethically correct response to such conflicts. In this revised edition, detailed background material has been added to many of the cases to foster more well-reasoned ethical decision making. In addition, cases on sexual harassment and advertising have been introduced, and those on financial and HIV issues have been updated. An entirely new chapter on the structure and obligations of the various professions has been added. This book will continue to be of value to members of the dental profession and is now better suited to the needs of ethics courses for dental students.
ISBN: 0-86715-443-8
978-0-86715-443-6 , 9780867154436
340 pp (softcover)
Contents
Part I: Ethical Questions: Theory and Principles
1. An Overview of Ethics in Dentistry
2. The Structure of Professions and the Responsibilities of Professionals
3. Basic Ethical Theory
4. Ethical Principles
5. Format for Resolving Ethical Questions
Part II: General Principles in Dental Ethics
6. Doing Good and Avoiding Harm
7. Fidelity: Obligations of Trust and Confidentiality
8. Autonomy and Informed Consent
9. Dealing Honestly with Patients
10. Justice in Dentistry
Part III: Case Studies of Special Problems
11. Ethical Concerns in Schools of Dentistry
12. Ethical Issues in Third-Party Financing
13. Ethical Issues Involving HIV and Other Bloodborne Diseases
14. Incompetent, Dishonest, and Impaired Professionals
Appendix 1: Codes of Medical Ethics
Appendix 2: Informed Consent
Glossary
Index
Preface to the Second Edition
In the 11 years since the first edition of this book was published, much has happened in the field of dental ethics. An ethics curriculum is now required in all US dental schools. New books on dental ethics have been published, including several from other countries, and two in this country are now in their second editions. The American College of Dentists has published an ethics handbook for dentists and now includes a section on dental ethics in each issue of its journal. The membership of the US-based Professional Ethics in Dentistry Network has increased significantly, and an international dental ethics association has been formed called IDEALS—the International Dental Ethics and Law Society.
Even as recognition of the importance of dental ethics has grown, concerns about the ethical foundations of the profession may also have increased. There is some unease within the profession—possibly also reflected in public attitudes—about a tendency for increasing numbers of dentists to put their own interests above those of their patients.
The second edition of this book is designed to deal directly with issues such as this. Its goals are the same as those of the first edition: to help sensitize dental professionals to the important role of ethics in dentistry and to provide a general approach to ethical reasoning in dental-related problem solving. However, in order to better implement these goals, we have made several important changes, some of which were shaped by constructive criticism of the first edition.
As a frame of reference for the rest of the book, we have included an entirely new chapter on professions. Using frequent references to dentistry, it begins with a brief history of the development of professions that is essential to understanding their structure and function today. It presents both the traditional idealized perspective of professions and the views of their critics. For professionals, both outlooks are required reading.
Of special significance for newcomers to the discipline of ethics is the expansion and modification of the format of the case discussions. The discussions now contain an increased amount of relevant background material and additional guidance in the techniques of ethical problem solving.
To find space for these innovations, two adjustments were made. One was to eliminate the chapter on research. (A few of its cases were retained and moved to other chapters.) We also eliminated cases that we had reason to believe were not widely used for discussion by students and others. The first edition contained 111 cases; the second contains 88.
The final important change was the introduction of new and timely cases—12 of the 88 did not appear in the first edition. Unlike the cases in the first edition, which were presented from the perspective of the individual practitioner, many of the new cases invite discussion on ethical issues faced by the entire profession of dentistry—for example, access to care, licensure, and the corporate sponsorship of graduate education.
Preface to the First Edition
Every day of their professional lives, dentists face decisions that have ethical content. Most often the issues involve the utilization of complicated diagnostic or technical skills in the delivery of patient care. The way these skills are used is based on the values of both the dentist and the patient. Every recommendation by a dentist and acceptance by a patient has ethical substance, in its potential for patients to be helped or harmed or their wishes and values to be respected or ignored. Sometimes a practitioner’s recommendation may conflict with what the patient wants. Sometimes what the patient wants may sound foolish to the dentist. How the dentist responds to these problems and many others determines the character of a dentist’s practice.
Some situations occur so often that they may not even be recognized as having ethical content. Other times the circumstances are complex, and the answers are not readily apparent. However, in both situations a background in philosophical ethics can be helpful as support for making sound decisions. Unfortunately, while technological advances and changes in societal perspectives over the last 20 years have increased the ethical challenges inherent within dentistry, the response of dental schools has been relatively recent. Further, although at present 80% of all dental schools offer courses in ethics, the emphasis in many is on jurisprudence.
This does not mean that dentists are not interested in or disturbed about ethical issues. In recent years, published reports have shown concerns about poor quality of care, violations of public trust, flagrant advertising, self-regulation, informed consent, interactions with impaired or incompetent colleagues, financial interactions with patients and insurance companies, and several others. Dental practitioners have developed a variety of approaches, including the reliance on values instilled during dental school, discussions with colleagues and consideration of the ADA Code of Ethics, and their own personal standards, to resolve these problems. However, a general approach to ethical reasoning in dental-related problem solving has not been available to either the dental practitioner or the dental student. This book is intended to address that deficiency.
James T. Rule, DDS, MS
Professor Emeritus
Department of Pediatric Dentistry
Dental School
University of Maryland
Baltimore, Maryland
Robert M. Veatch, PhD
Professor of Medical Ethics
The Kennedy Institute of Ethics
Georgetown University
Washington, DC
Reviews
“This is a very good overview of ethics in dentistry, with a strong emphasis of the philosophical basis for ethical decision making and practical examples for doing so. Because it makes a somewhat esoteric issue informative and interesting, it is recommended for all practitioners at whatever stage in clinical practice they might be.”
Michael R. Breault, DDS
The New York State Dental Journal January 2005
"This book is essential reading for all dentists who practice dentistry. Although not related directly to technical aspects of clinical dentistry, it enlightens the reader on what thinking must accompany the rendering of appropriate dental care, namely the issues relating to practising dentistry ethically..."
Reviewed by Rollin Matsui, BSc, DDS
Alpha Omega Book Review
"...The 88 cases discussed throw up a lot of questions but this is deliberately intended to make the reader think very carefully about the consequences of their actions and inactions. Dentistry is not just about repairing the contents of the human mouth, it is also about dealing with human beings who demand and are entitled to the respect afforded by such essentials as informed consent and autonomous choice. Although the cases involve a degree of philosophical, sometimes theoretical, debate in terms of Hippocratic responsibility on the part of the dentist to the patient, there are also many instances of substantial pragmatic concern to all dentists, such as the cases of HIV-infected patients. A fascinating and mind-expanding read."
Reviewed by Roger Farbey
BDAnews, Vol 17, No 12
December 2004
"...The book remains a most accessible contribution to the professional literature on dental ethics...
Each case study is followed by concise discussion and analysis of the ethical considerations involved and, where appropriate, guidance is offered. Often though, the discussion highlights the key questions requiring the practitioner's judgment. This is valuable, since ultimately each practitioner is responsible for ensuring that their own value system and practice methodologies reflect an ethical perspective which marks them as "professional". A book which sought to deliver pre-packaged answers to all ethical dilemmas would miss the point. Thankfully, this book doesn't."
Reviewed by Garry Pearson
ADAVB Newsletter
March 2005
© 2004
